Toby Peters

As researchers the world over race to develop, test and manufacture a coronavirus vaccine, an equally important discussion that should be on the agenda is the distribution of the life-saving medication and the cold chain infrastructure needed to support this massive undertaking, says Toby Peters, Professor in Cold Economy, University of Birmingham, United Kingdom. “How do we vaccinate seven billion people rapidly?” he asks, “Is this the biggest logistical challenge the world has ever faced?”

Peters says that while the majority of countries, to a greater or lesser extent, have temperature-controlled supply chain to collect, store and move blood, vaccines and medicine, the same cannot be said of developing countries, where vaccine access continues to be a major challenge due to lack of cold chain. He points out that in the current logistics chain, 20% of vaccines are lost owing to temperature excursions and that if in 2021 we need to have two billion vaccines ready, we have to ask ourselves whether we can afford to potentially lose 500 million of those.

In addition to protecting infants and the vulnerable from preventable diseases, Peters says, mass population vaccination across urban and remote economies is crucial for the protection of the economy and the continuous operations of nations. “Does any country today have the existing infrastructure, resources and data-capturing management to meet the demand for COVID-19 to vaccinate the majority of its population rapidly and, potentially, annually?” he asks.

Peters says that there is only a short window for countries to prepare, as the vaccine will most likely be ready for mass distribution in the following 12 months. “While the quantum of vaccine cold chain can be estimated considering population sizes, I think the ground-level conditions, the last mile point of use, conditions of the cold chain, the gaps and opportunities relating to potentially complementary alternative solutions, the local needs – all need to be better understood,” he says.

Peters says that these barriers are especially amplified in rural communities. where the last mile is usually the weakest link in the supply chain. Central to this, Peters adds, is energy supply. “In the world’s poorest countries, reliable electricity supply is a major challenge,” he says. “In Uganda, for example, more than 70% of healthcare facilities have inadequate access to main power.”

For Peters, it is also important to remember that securing an effective cold chain is not just about a vaccine fridge – it’s about addressing all the pieces that work together. “The pallets which move it in planes, the vehicles that move it to the local healthcare sector and then the motorbikes and the people that take it right to the remotest communities – all these have to work seamlessly,” he says. “This is where we want to start thinking.”

Essentially, Peters says that mass vaccination for COVID-19 will require a new approach to assess, re-engineer and build upon available cold chain logistics access to effectively roll out vaccine at a scale and speed never considered, all while still protecting existing immunisation needs. “We have to make sure that this uplift in energy demand and technology demand doesn’t come with an environmental penalty,” he says. “I think with planning, we can build up better with positive legacy – we can create a long-term health logistics framework that is cost effective and responsive to future needs and challenges, while developing pathways to net-zero-health-cold-chain.” This, he says, can be achieved by evaluating new strategies for modal shifts and looking into the presence and appropriateness of alternative cooling facilities in order to provide the local governments with cost-effective interventions and alternatives to
meet this challenge.

In line with this, Peters encourages stakeholders to look into optimising existing cold chain that does not handle medical supplies. Posing a challenge to the industry, he asks, “Should we be thinking about creating a new emergency approach, which gets part of the food cold chain ready as a backup to humanitarian logistics, as and when necessary? Equally, when it comes to the last mile and point of use, can we start looking at new logistics models, modal shifts and new equipment?” Peters believes that there is scope to utilise food logistic capacity in developed countries or temporary facilities, such as inflatable cold rooms, to create decentralised cooling hubs as potential lifeboats to close the demand. He also highlights the need to evaluate the role of drones, electric cargo bikes and off-grid solar fridges for lasting remote outreach in developing countries, keeping the time-frame in mind.

However, Peters is quick to point out that these efforts also have to be supported by proper training of healthcare workers to ensure they are able to deliver the vaccines as well, as of the engineers to secure proper maintenance of the equipment. “Getting this right is vital on so many levels, but planning may enable for choices to be optimised and short-term results to be delivered, while simultaneously building a system and infrastructure that will give lasting value in the future,” he says, “Because whilst COVID-19 is potentially an outlier, and its unknown if we should have a one-time vaccine or would need annual vaccination – we are likely to see an increase in shocks, natural disasters and epidemics, which require a rethink of emergency humanitarian logistics in a warming world.” While the challenges remain immense, Peters says society should use the current situation as a springboard for discussions on how to achieve resilience in humanitarian logistics and cultivate a global medical supply chain at regional and national levels for natural disasters and epidemics without reliance on fossil fuel sources.

The Feature relied on excerpts from the discussion during the webinar, Vaccine Virtual, on August 19, 2020, organised by CPI Industry, as part of its HVACR Virtual Conference Series.